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UK National Audit of Sexual History Taking

UK National Audit of Sexual History Taking. Case notes audit Clinic policies audit Audit against standards and recommendations in the BASHH 2006 National Guidelines – consultations requiring sexual history-taking http://www.bashh.org/documents/84/84.pdf.

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UK National Audit of Sexual History Taking

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  1. UK National Audit of Sexual History Taking Case notes audit Clinic policies audit Audit against standards and recommendations in the BASHH 2006 National Guidelines – consultations requiring sexual history-taking http://www.bashh.org/documents/84/84.pdf

  2. UK National Audit of Sexual History Taking Case notes audit

  3. Case notes audit Case notes of 4121 patients were audited during 1 January 2008 to 31 March 2008 Sample number for each centre: first 30 patients seen in the audit interval On-line submission of data

  4. Case notes audit 153 clinics (about 60% of all GU Clinics) were surveyed from all 14 English BASHH regions and Scotland, Wales and Northern Ireland   3242 (79%) new patients 879 (21%) re-books 2061 (50%) males 2060 (50%) females

  5. Case notes audit Auditable outcome measure 1: the proportion of new/rebooked patients asked about the gender of their last sexual partner (target >95%) Recorded in 94% of cases (96% in homosexual/bisexual men and 94% in heterosexual men and women) (Regional range 80-100%)

  6. Case notes audit Auditable outcome measure 2: the proportion of new/rebooked patients asked about condom use at the last sexual intercourse (target >95%) For vaginal intercourse: recorded from 85% of males and 87% females (R.R. 71-95%) For anal sex: homo/bisexual men - 70% (R.R. 44-93%) women - 8% (R.R. 1-21%)

  7. Case notes audit Auditable outcome measure 3: New/rebooked patients should have comprehensive histories taken and legibly recorded (Target >90%) 95% of cases-notes were deemed completely legible (R.R. 83-100%) Achievement of comprehensiveness is assessed in detail in the results section of the paper

  8. Case notes audit Auditable outcome 4: An HIV risk assessment should be taken in all new/rebooked patients (>90%). This is described in the Guidelines as having six components The worst level of recording was about medical treatment abroad (with a risk of HIV): 23% (R.R. 5-51%) The best was for a history of injecting drug use: 80% (R.R. 49-97%)

  9. Case notes audit Auditable outcome 5: The sexual history should be retaken and documented at least every six months in those being followed up for infectious conditions’ (target 100%) Previously audited in National Audit of Sexual Health of HIV patients Not part of this Audit

  10. Case notes audit GMC states: Wherever possible, you should offer a chaperone) during an intimate examination Recorded in 54% of cases (R.R. 21-81%)

  11. Case notes audit: Suggested areas for practice improvement/interventions A high proportion of the case notes were deemed to be completely legible Interventions are especially required to improve the recording of the following areas of practice: condom usage, HIV risk assessment, and the offer of a chaperone

  12. UK National Audit of Sexual History Taking Clinic policies audit 145 (57%) clinics participated

  13. Clinic policies audit Recommendation 1: Sexual history-taking should take place in a confidential, private environment 99% (R.R. 92-100%) of clinics

  14. Clinic policies audit Recommendation 2: All clinics should have a confidentiality policy that should be displayed in the waiting area or otherwise made available to patients 47% (R.R. 15-75%) displayed their confidentiality policy in the waiting area 70% (R.R. 43-100%) made it available in other ways

  15. Clinic policies audit Recommendation 3: Clinic literature/advertising leaflets should include sections regarding the need to take a sexual history 68% (R.R. 33-100%)

  16. Clinic policies audit Recommendation 4: Assessment of clinician communication skills should form part of the assessment of service quality 60% (R.R. 0-100%) Of those clinics performing assessments: 78% (R.R. 33-100%) used patient surveys and 53% (R.R. 17-83%) employed recorded/witnessed consultations

  17. Clinic policies audit Recommendation 5: All sexual health clinics should have policies in place to address the needs of patients with whom there are communication problems First language not English: 86% (54-100%) Hearing difficulties: 51% (20-92%) Learning difficulties: 49% (22-83%)

  18. Clinic policies audit Selected key components Four clinics did not have policies to document, for all under 16 year olds, an assessment of their competency to consent to history taking and examination

  19. Clinic policies audit Selected key components Twenty clinics did not have a policy to document the offer of a chaperone This contravenes the General Medical guidelines on Intimate Examinations

  20. Clinic policies audit: Conclusions and suggested areas for practice improvement A high proportion of clinics have policies on most of the areas recommended in the Guidelines Interventions are required to ensure that all clinics offer chaperones and record this, and that all clinics assess the competency of under 16 year olds to consent to history taking and examination

  21. Clinic policies audit: Conclusions and suggested areas for practice improvement The need for other local policies, as described in the guidelines, should be discussed within clinics and at regional audit groups

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